Normal nonfluency of speech typically occurs in children between ages two and seven, with a heightened occurrence between 2 ½ and 4 years
In young children, typical nonfluent speech is initially episodic, then becomes more cyclical in nature, coming and going without apparent cause or pattern. The following are characteristics of normal nonfluencies (Guitar 1998):
- No more than ten disfluencies per one hundred words.
- Most repetitions are only one or two repetitions in length.
- Repetitions are easy, loose and relaxed with no apparent sign of tension or struggle.
- The most common normal disfluencies are interjections (um, uh), revisions and whole word repetitions. As children mature past three, they will show a decline in part-word (sound or syllable) repetitions.
- When the disfluencies occur, the child’s body is in motion and they will appear relaxed. Most of the time they will appear as if they are unaware of the disfluencies and will continue talking without interruptions.
Most children between the ages of 2 ½ and 7 years of age experience nonfluencies and disruptions in their speech. In most children, this period of nonfluency is normal. However, some children may be exhibiting early warning signs or danger signs of a potential stuttering problem. Timely and appropriate identification of these danger signs is critical to the prevention of a confirmed stuttering problem.
Listed below are the warning or danger signs frequently observed in the speech of young children who are at risk for developing a chronic stuttering problem. The frequent and consistent occurrence of any of these behaviors in a young child’s speech would identify a child at serious risk.
- Multiple part-word repetitions: The child repeats the first sound or syllable of a word, such as t-t-t-table or ta-ta-ta-table.
- Prolongations: The child stretches out a sound, such as rrrrrrrrabbit.
- “Schwa” vowel: Use of the weak (schwa in German) vowel. For example, instead of saying bay-bay-bay-baby, the child substitutes b^b^b^baby.
- Struggle and tension: The child shows struggle and force in an attempt to say a word. Parents may observe tension around the child’s mouth, eyes or in the child’s body posture.
- Pitch and loudness rise: As the child repeats and prolongs, the pitch and loudness of the voice increase.
- Tremors: Uncontrolled quivering of the lips or tongue may occur as the child repeats or prolongs sounds or syllables.
- Avoidance: The child shows an unusual number of pauses; substitutions of words; interjections of extraneous sounds (um, uh), words (like, well) or phrases; avoidance of talking; or talking in funny voices.
- Fear: The child recognizes that certain words are likely to be troublesome, and may display an expression of fear when about to say those words.
- Difficulty in starting or sustaining airflow or voicing for speech: This is heard most often when the child begins sentences or phrases. Breathing may be irregular and speech may come in spurts as the child struggles to keep the voicing continuous.
Source: If Your Child Stutters: A Guide for Parents, Stuttering Foundation of America, Memphis, TN, 1-800-992-9392.
Anytime a child exhibits heightened negativity, negative awareness or struggle and tension during speaking, there is cause for concern.
Please click here to see our Developmental Levels of Disfluency chart.
Many factors are believed to signal that a child is at high risk for chronic stuttering.
Important risk factors to consider include:
- Time Post Onset: The longer the child continues to stutter, the greater the risk. Spontaneous recovery begins at approximately six months post onset and can continue up to a year post onset. The likelihood of chronicity increases approximately fifteen months after onset.
- Family History of Stuttering: Research has indicated that relatives of stutterers are at greater risk for developing stuttering than relatives of non stutterers. Both genetic transmission and social inheritance theories have been proposed to explain the tendency for stuttering to occur in families. To date, the cause of this familial link has not been explained. It is estimated that 25% of chronic stuttering has this familial link.
- Persistent Prolongations: The presence of prolongation behaviors in a child’s speech appears to be an important indicator of chronicity of stuttering (Mairi and colleagues, 1996).
- Concomitant Speech-Language Difficulties: Research has found that stutterers have 2 ½ times the incidence of articulation disorders as non stutterers (Andrew and Harris, 1964; Berry, 1938; Bloodstain, 1958; Kent and Williams, 1963). Evidence also exists that children who stutter lag behind fluent children in language development. Significant deficiencies in syntax and word finding may directly affect a child’s ability to string together words in a smooth, fluent manner.
- High Self-Expectations: Perfectionistic tendencies in young children who stutter may lead them to have less tolerance of the disfluencies in their speech and more at risk to develop chronic stuttering.
- Heightened Negative Awareness: Guitar (1998) notes that the child’s response to the awareness of their stuttering is the underlying factor in the progression of stuttering.
- Lower Risk Indicators
- No family history
- Female gender
- Decreasing disfluency over time
- Less than 6 months since onset
- No physical tension/secondary behaviors
- No frustration or awareness
- Primarily repetitions
- Earlier onset of stuttering
- No other speech/language disorders
The more risk factors a child has, the greater the chance that the child will develop chronic stuttering.
The following is a checklist to help you determine if the child should be evaluated by a fluency specialist.
Instructions: Parents/teachers check any area that applies to the child:
I. Risk Factors
II. Speech Behavior
If two or more questions are checked, the child needs to be seen for consultation or evaluation.
Please contact the Center of Stuttering Therapy to schedule a consultation or evaluation.
Many children between the ages of two and four years go through a stage when they seem to stutter. This disfluent speech can be very disturbing to parents.
When your child is experiencing disfluencies in their speech, the following suggestions may be helpful when communicating with your child:
- Take care not to draw negative attention to the speech difficulties. Instead:
- Listen patiently until the child is finished speaking, while maintaining consistent, appropriate eye contact.
- Try to avoid showing concern, pain, or pity on your face.
- Respond the same to disfluent speech as you would to fluent speech.
- Repeat back to the child what they said in a slow, relaxed manner. This will tell the child you were listening to what was said rather than how it was said.
- Try to use slower, more relaxed speech (easy speech) whenever you are communicating/talking with your child. This is difficult to do at first, but will become easier over time. Begin slowly, gradually increasing the use of “easy speech” during all daily activities. It is not advisable to draw attention to the child’s rate of speech. Instead simple provide this “easy speech” model whenever possible.
- Speak to your child in short, simple sentences using vocabulary appropriate for his age. Disfluencies will increase with longer, more complex utterances. Children frequently attempt to match adult language models.
- Try not to convey a sense of time pressure. Give your child adequate time to respond. Try to avoid rushing or asking him to hurry. Inserting adequate pauses in your speech will help reduce time pressure.
- Suggestions such as “slow down”, “think about what you are saying”, “start over”, and “take a deep breath” are not helpful and will only serve to frustrate your child during moments of speech difficulty.
- Protect your child’s talk time by limiting interruptions. Appropriate turn taking skills should be used by the entire family.
- If your child appears unaware of his disfluencies, avoid talking about the “stuttering” in his presence. In addition, do not label the disfluencies as “stuttering”.
- Avoid extensive open-ended questioning. Instead ask yes-no questions or short answers questions whenever possible.
- When your child is experiencing increased disfluencies, encourage more nonverbal or physical activities, such as coloring, outdoor recreation, and movies, etc. On more fluent days, encourage talking as appropriate.
- In all daily activities, attempt to make talking a positive and fun experience for your child. We suggest:
- Positive verbal praise for talking (i.e., “you are a good talker”, or “I like the way you said that”.)
- Talk about things that are important and of interest to your child.
- Allow your child to initiate conversations.
- Read frequently to your child in a slow and relaxed manner.
Below is our “REST” acronym. Posting copies of these in strategic places in the home (i.e., refrigerator, play area, car etc.) will serve to reinforce important information to help you make positive changes in your communication patterns with your child:
- R – Repeat back
- E – Eye contact
- S – Slow, easy speech
- T – Turn taking
When parents have concerns about their child’s persistent stuttering, it is highly recommended that they contact a speech-language pathologist who has expertise in stuttering. The American Speech-Language Hearing Association’s (ASHA) Division 4-Fluency, suggests parents look for a Board Recognized Fluency Specialist. Speech pathologists with this distinction have received extensive training and experience in the diagnosis and treatment of stuttering disorders.
Individuals looking for referrals in their area for fluency specialists can contact the Stuttering Foundation of America (SFA) for a referral list. You may call the SFA at 1-800-992-9392, or visit their website at www.stuttersfa.org.
Differential diagnosis is the key to effective early intervention. It is critical to have your child evaluated by a speech-language pathologist with fluency expertise in order to accurately determine whether your child’s disfluencies are normal or abnormal.
Please visit our stuttering facts page to learn interesting facts about stuttering.
The Stuttering Foundation of America provides helpful information on their web site: Insurance Coverage